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Understanding the Side Effects of Doxycycline on Tendons and the Benefits of Physical Therapy at OrMobility Physical Therapy & Performance

Side Effects of Doxycycline on Tendons and the Benefits of Physical Therapy 1
Dr. Garrett Stroup. Physical Therapist in Roseburg Area.


Dr. Garrett C. Stroup

DPT, VRC - Owner and Founder

We help athletes and active adults regain control of their injury without expensive surgeries or medications, so they can keep going.


At OrMobility Physical Therapy & Performance in Roseburg, Oregon, we’ve observed an increase in patients with long-standing symptoms of Lyme disease. Many of these individuals experience severe tendon ruptures during treatment, often initially appearing unassociated. However, further investigation reveals a link to the side effects of doxycycline, a common antibiotic used to treat Lyme disease. This blog post will delve into the side effects of doxycycline on tendons and discuss how our specialized physical therapy can significantly aid recovery.

What is Lyme Disease?

Lyme disease, caused by the bacterium Borrelia burgdorferi, is transmitted through the bite of infected black-legged ticks, also known as deer ticks. According to the Centers for Disease Control and Prevention (CDC), Lyme disease is the most common vector-borne disease in the United States, with an estimated 300,000 cases annually.

Symptoms of Lyme Disease

Symptoms of Lyme disease can vary and are typically categorized into early and late stages:

  • Early-Stage Symptoms:
    • Erythema migrans (EM) rash, characterized by a “bull’s-eye” appearance.
    • Flu-like symptoms such as fever, chills, fatigue, body aches, headache, neck stiffness, and swollen lymph nodes.
  • Late-Stage Symptoms:
    • Joint pain and swelling, particularly in the knees.
    • Neurological issues, including severe headaches, facial palsy, nerve pain, and tingling in the extremities.
    • Cognitive impairments such as memory loss and difficulty concentrating.
    • Heart problems, including Lyme carditis, which can cause irregular heartbeats.

Treatment of Lyme Disease with Doxycycline

Treatment of Lyme Disease with Doxycycline


Doxycycline: An Overview

Doxycycline is a broad-spectrum antibiotic commonly used to treat various bacterial infections, including Lyme disease. It is particularly effective in early-stage Lyme disease and in preventing the bacteria from multiplying. Doxycycline is often prescribed for adults and children over the age of eight.

Side Effects of Doxycycline

While doxycycline is effective in treating Lyme disease, it can have several side effects. Common side effects include gastrointestinal upset, photosensitivity, and allergic reactions. However, one of the more severe and less frequently discussed side effects is its impact on tendons.

Doxycycline and Tendon Damage

Research has shown that doxycycline, along with other antibiotics in the tetracycline class, can adversely affect tendons. Studies have indicated that these antibiotics can lead to tendonitis and even tendon rupture, particularly in weight-bearing tendons such as the Achilles tendon.

  1. Mechanism of Tendon Damage:
    • Doxycycline can disrupt collagen synthesis, which is crucial for maintaining the structural integrity of tendons.
    • It can also induce oxidative stress in tendon cells, leading to cellular damage and weakening of the tendon structure.
    • Additionally, doxycycline may interfere with tendon repair processes, making them more susceptible to injury and rupture.
  2. Clinical Evidence:
    • A study published in the Journal of Clinical Rheumatology highlighted cases of Achilles tendon rupture in patients treated with doxycycline for various infections.
    • Another study in the Journal of Antimicrobial Chemotherapy reported an increased risk of tendon injuries in patients on long-term doxycycline therapy.

The Role of Physical Therapy in Managing Tendon Damage

At OrMobility Physical Therapy & Performance, we understand the unique challenges faced by Lyme disease patients, particularly those experiencing tendon damage as a side effect of doxycycline. Physical therapy plays a crucial role in managing and rehabilitating tendon injuries, helping patients regain strength, mobility, and function.

Benefits of Physical Therapy for Tendon Damage

  1. Pain Management:
    • Techniques such as manual therapy, ultrasound, and electrical stimulation can help reduce pain and inflammation in affected tendons.
  2. Improving Mobility:
    • Stretching and range-of-motion exercises can help restore flexibility and prevent stiffness in the joints and tendons.
  3. Strengthening Muscles:
    • Targeted strength training exercises can rebuild muscle strength and support the tendons, reducing the risk of further injury.
  4. Promoting Healing:
    • Physical therapy can enhance the healing process by increasing blood flow to the injured tendons and promoting tissue repair.
  5. Preventing Future Injuries:
    • Educating patients on proper body mechanics, posture, and preventive strategies can help reduce the likelihood of future tendon injuries.

Comprehensive Physical Therapy Approach at OrMobility

Side Effects of Doxycycline on Tendons and the Benefits of Physical Therapy

At OrMobility Physical Therapy & Performance, we offer a comprehensive and personalized approach to managing tendon injuries caused by doxycycline. Our program includes:

  1. Initial Assessment and Personalized Treatment Plan:
    • A thorough assessment of the patient’s medical history, symptoms, and specific needs.
    • Development of a customized treatment plan focused on pain reduction, mobility enhancement, and strength training.
  2. Targeted Interventions:
    • Manual Therapy: Techniques to reduce pain, improve tissue extensibility, and enhance joint mobility.
    • Modalities: Use of ultrasound, electrical stimulation, and heat/cold therapy to manage pain and inflammation.
    • Exercise Therapy: Tailored exercises to improve flexibility, strength, and function of the affected tendons.
  3. Neuromuscular Re-education:
    • Exercises and activities designed to retrain the nervous system and improve coordination and movement patterns, which can be disrupted by tendon injuries.
  4. Patient Education and Self-Management:
    • Providing patients with information on proper body mechanics, activity modification, and home exercise programs to support ongoing recovery and prevent recurrence.

Case Studies and Success Stories

Our clinic has successfully treated numerous patients with tendon injuries related to doxycycline use. Here are some success stories:

  • Case Study 1: A 50-year-old man with a partial Achilles tendon rupture experienced significant improvement in pain and function after a 12-week program of manual therapy, strengthening exercises, and neuromuscular re-education.
  • Case Study 2: A 35-year-old woman with tendonitis in the shoulder regained full range of motion and strength following a comprehensive treatment plan that included modalities, stretching, and progressive resistance exercises.


Lyme disease is a complex condition that requires a multifaceted approach for effective management. While doxycycline is an essential treatment, its potential side effects on tendons necessitate careful monitoring and intervention. At OrMobility Physical Therapy & Performance, we are committed to providing specialized physical therapy services to address these challenges and support patients in their recovery journey.

Our comprehensive and personalized approach aims to alleviate pain, restore function, and improve overall quality of life for those affected by Lyme disease and its treatments. If you or a loved one are experiencing tendon issues related to doxycycline use, contact us today to develop a tailored plan to support your recovery and wellness.


  1. Centers for Disease Control and Prevention (CDC). Lyme Disease. Available from: https://www.cdc.gov/lyme/index.html
  2. Wormser, G.P., et al. (2006). The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases, 43(9), 1089-1134.
  3. Hu, L. (2016). Lyme Disease. Annals of Internal Medicine, 164(9), ITC65-ITC80.
  4. Marques, A. (2008). Chronic Lyme Disease: A Review. Infectious Disease Clinics of North America, 22(2), 341-360.
  5. Cameron, D.J., et al. (2004). Evidence-based guidelines for the management of Lyme disease. Expert Review of Anti-Infective Therapy, 2(1), S1-S13.
  6. van der Linden, P.D., et al. (1999). Achilles tendinitis associated with fluoroquinolones. British Journal of Clinical Pharmacology, 48(3), 433-437.
  7. Khaliq, Y., & Zhanel, G.G. (2003). Fluoroquinolone-associated tendinopathy: a critical review of the literature. Clinical Infectious Diseases, 36(11), 1404-1410.

By providing this structured and evidence-based guide, we aim to enhance our community’s understanding of Lyme disease treatment side effects and promote effective management strategies through physical therapy.

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